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Old 04-22-2017, 08:24 PM   #41
Aqua Puttana
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Default Re: A DIY Eye Cataract Test

I'm heading toward my second (right - dominant eye) cataract IOL Intra Ocular Lens implant surgery next week. Abbott Medical Optics brand. Catarct surgery is something that will likely only happen once for most people. I know that this event has been a steep learning curve for me. As a layman, I will outline some of the things which I've learned to date. I am not in any way a medical professional.

There are not many old farts who aren't on a bunch of medications. This old fart taking only one 81 mg aspirin per day for meds made me qualify for an approved study for eye drops. That gave me additional visits to my surgeon which added to my knowledge base as it gave me more chances to ask questions.

I'll mention the eye drops first. Likely you will be doing a bunch of eye drops. The drops for me started the day before my surgery and continued for weeks after. My wife was around to apply my drops. That made things easier. Some of the drops are quite thick. If you are applying the thick drops on your own, more than a few times you will probably hit your cheek rather than into your eye. Keeping the drops in the refrigerator helps to know if you hit the target. It is easier to feel a cold drop hit your eye.

The day after my surgery my eye teared quite a bit and had a bit of pain. The study limited my meds. At that time I was only allowed antibiotic drops. There is automatically a check-up appointment the day after surgery. My study drops started 10:00 a.m. at that appointment. The pain and tears stopped quickly after that first study drop was applied. From then on I had no tears or pain to mention.

Following surgery my study drops were 2 times per day (morning/evening) with an antibiotic drop Ofloxacin 0.3% 3 times per day (I used 9 - 3 - 9 timing). That was for about 2 weeks. Per the study instructions I stopped the study drops a day before an evaluation appointment. Normally drops will continue for weeks. That one day without drops I noticed that tears and a bit of pain of my eye returned (maybe more an awareness than actual pain). I was more aware of my eye for those next days of evaluation. The Doc said that was expected. A rebound effect.

Following my study evaluation visits I was given prescription drops Prednisolone AC 1% (non-study drops) with a 3 time/day schedule for week 1, 2 time/day schedule for week 2, followed by 1 time per day for week 3 (taper off). The Prednisolone drops eliminated the tears and the "awareness" of my eye. So my take away, or advice here is USE THE DROPS AS YOU ARE INSTRUCTED. They will keep you more comfortable. A caution per my surgeon: Whenever wiping the eye after surgery never wipe or dab directly. Don't get closer than your cheekbone. You really don't want an infection.

Medicare
Not long ago Medicare used a degree scale of cataract progression to determine when they would pay for the surgery. Medicare now uses a quality of life standard. Basically if you have catarcts forming and tell your eye doctor that it is affecting your night driving or other tasks, Medicare will cover.

With my supplemental insurance my surgery cost me $75.00 per eye with some $20.00 co-pays out of pocket. Standard IOL replacemnt is what Medicare covers.

My knowledge as to choices of IOL implants.

First. As might be expected, there is a bit of art in the surgeon choosing the proper lens. The after IOL implant distance vision will be around 20/20, but may not be exactly 20/20.

Select monofocal distance vision for both eyes. (You will need glasses either to drive or to read, not both.)
"Distance" both eyes.
You get approx. 20/20 distance vision. You will not need corrective lenses for driving. You will need corrective lenses (cheaters) for reading.

"Around the house" both eyes.
You can read, watch TV, etc. Corrective lenses will be needed for driving.

Multifocal IOL.
Basically IOL with built in bifocals like in your glasses. For me it would have been a $2600.00 per eye up charge out of pocket.

Monovison = 2 IOL's. One distance, one close(r). (far/near)
Generally the dominant eye is corrected to 20/20 with the opposite eye corrected to some level of nearsightedness. Corrective lenses will not be legally required for driving. Depth perception is somewhat affected. There may be a slight out of pocket up charge over monofocal lenses.

I'm told some people just can't adjust to multifocal or monovision near/far lenses. My DIY test was to pop a lens out of an old pair of glasses and go a day in that mode. I found that I quickly adjusted to the two different lenses.

If you choose the multifocal or monovision different lens (far/near) option and just can't live with it, the offending lens can be replaced with a subsequent surgery. I'm told it is best to not wait too long for that 2nd surgery. I have no idea how Medicare or insurance would deal with that.

My monovision experience to date.
(Left non-dominant eye 20/20 and my right dominant eye very nearsighted = no correction as yet.)

With my left eye IOL 20/20 and right nearsighted I don't need glasses at all to function. Reading, phone text, computer work, driving is all ok. My night vision is not what it was. I have always been blessed with good night vision to the point that I didn't understand what people were complaining about. Now with my monovision mode I can appreciate what it is like. I can see at night, but it takes much more concentration even as compared to my cataract eyes with corrective lenses. I find that I need to concentrate on using my left eye. Night driving is no longer so relaxed. My future plan for night driving is to wear glasses to correct my nearsighted eye. I hope that restores my night vision to what it was.

Astigmatism.
I was offered full corrective surgery to completely correct my astigmatism. $900.00 per eye out of pocket. A lesser surgery would correct about 90% of my astigmatism for an additional $100.00 eye. Night myopia and astigmatism may affect night driving. Even so, I selected the 100 bucks per eye. So far it seems fine.

Note:
This information is provided after only one eye cataract surgery. I was going to wait until both eyes were complete, but my old brain might lose some details by then. I will follow up after my right eye surgery, and also after my eyes stabilize to allow me to get my night driving/shooting glasses prescription.
Poor word use. I will not be killing deer at night. Maybe with a fender or bumper, not with a firearm.

After/during surgery my right eye will get a Tri-moxi antibiotic injection which eliminates the need for antibiotic drops. It will be interesting to compare an injection to my study drops and Ofloxacin 0.3% drops as to eye comfort. I believe that Tri-moxi is limited to use depending upon the individual. The shape/size of the eyeball or near vs farsighted eyes may be a factor.

vic
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Old 07-09-2017, 01:15 PM   #42
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Default Re: A DIY Eye Cataract Test

I've waited to follow up here on my right eye cataract surgery. I'm very pleased with the results of having a 20/20 eye and a nearsighted eye. I don't need glasses. I see everything well.

I used antibiotic eye drops for my surgery in my left eye. That worked very well.

For my second eye I had a Tri-moxi injection as antibiotic treatment. Tri-moxi replaces the more expensive drop regiment which is used for many patients.

Tri-moxi Floaters

Be ready for some disturbing floaters after the surgery! I was warned that floaters would be a problem, but I didn't expect what happened. Floaters are spots and threads floating around in the field of vision.

Day 0 - Tuesday Surgery Day
My vision was a bit cloudy in the right surgical eye. It seemed a bit worse than the left eye did at that time. I was told that the Tri-moxi would be a "blob" in my field of view.

Day 1 - Wednesday Day After
The day following surgery I woke up to what appeared to be heavy black pepper obscuring my vision. It was quite disturbing. The was also a clump of "hair" that moved in and out of my vision. The density of the pepper screen diminished a bit after a short time. In my day after exam I mentioned the pepper. The Doc said that the floaters should go away in a short time. It didn't give me warm and fuzzy that he used "should" rather than "always".

Day 2
I awoke to heavy black pepper in my surgical eye. The clump of "hair" had become more pronounced and was frequently in my field of view. The pepper again diminished after a while, but the clump of hair with dandruff pieces floated around all the time. The pepper effect remained in the background for the rest of the day. The dandruff hair remained heavy and continually moved into my field of view until bedtime. Clear vision had not returned as quickly as with the study drop left eye. I was beginning to regret not just going with a drop regiment similar to what I used with the left eye. (The study drops program was for just one eye.)

Day 3
Finally the dandruff hair has diminished to just some chunks of dandruff. The dandruff was still connected as the remaining 3 spots moved basically in unison, but that hair floater is noticeably less heavy. There was a bit of pepper effect upon waking up, but not very heavy. An interesting effect was that after waking up I had moving light gray pepper "constellations" showing rather than black pepper spots. The constellations quickly diminished. The rest of the day I had my old friends the dandruff spots moving around. There was some black pepper effect. I needed to concentrate to see it.

Day 4
Hurray. No field of black pepper. The 3 spots seem to have left me. There is still a bit of black pepper and a small floater (or maybe more than one?) that moves in and out of view, but nothing like my other mornings. At this stage the right eye after the injection still doesn't seem quite as clear as I recall my left eye with drops. This evening I noticed that there is a slightly blurry blob that moves around in my field of view similar to the previous dandruff floaters. I have felt that my right eye vision wasn't as crisp as I expected. When viewing a light colored computer screen the blob causes different general blurry areas as I purposely move my eye around. I expect that the blur blob will go away as the floaters have already.

Day 5
Small specs of black pepper still pop up here and there. The blurry blob is still there. It is only really obvious when viewing a computer screen with lots of white Eg. - Microsoft Word Doc. Mostly the blurry blob isn't really noticed except that now I'm aware of it so I can't resist testing to see if it is still there.

Day 6
Some small pepper. The blurry blob, or maybe blurry blob areas are still evident if concentrating on noticing them. The blurry blob(s) may be getting less pronounced. I'm hopeful that my right eye will eventually attain the clarity that I have in my left eye.

Day 7
The blurry blob continues to hang on. Some pepper still too. My left eye is clear as a bell. (Well, except that the bell reference is for ears.)


http://www.healio.com/ophthalmology/...surgery?page=1

***************

Advance to today.

I still have a slight blurry blob that wanders around in my right eye. It seems to have diminished, but maybe I'm just getting used to it. My left eye remains very clear.

The Doc says that the blurry blob has nothing to do with the Tri-moxi injection. I want to believe him, but in the back of mind I'm kicking myself for just not doing drops as were used in my left eye. To be clear, the blurry blob is an annoyance, it isn't really affecting my vision that much.

From what I've learned the biggest advantage of the injection is that it avoids the drop schedule not being properly followed. There is also some advantage with the medication being injected right into where it is needed. If you have no mitigating health issues and you can stay with a drop schedule my suggestion would be to use drops and avoid an injection.

That is my prejudice. I have no data.

Soon after the surgeries. I bought a pair of cheap blue lens sunglasses. I had no reason to do that other than I finally could. I never could use cheap sunglasses when I needed my prescription lenses.

I have yet to take the time to order my prescription driving glasses. I do want to do that before my next drive straight through road trip.

vic
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Old 09-07-2017, 03:14 PM   #43
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Default Re: A DIY Eye Cataract Test

My wife decided to have her cataracts addressed to improve her night vision. The Doc required her to do a contact in one eye only pre-test before letting her select mono vision (near/far eyes). She had no problems so mono vision is her choice. She also was advised that her astigmatism was bad enough that laser correction was needed. About $1000.00/eye additional for that.

First eye done last Tuesday 9/5.
Her surgery went very well. As with many of us, after the first surgery she discovered that colors look brighter. Her cataracts were worse that even the Doc had realized.

He mentioned that her pupils didn't open as much as they should. He performed a procedure that helps to open the pupil better.

My wife, her mother and sisters have always been "all the lights on in the house" people. I asked the Doc if the small(er) pupil thing could be hereditary or at least run in families. He agreed that it could be a factor.

Tri-moxi injection

My wife decided to get the Tri-moxi injection to reduce the number of drops. Her right eye didn't have any of the black pepper and dandruff hair floaters which I experienced. She said there were a couple of mild floaters that went away.

It appears that my reaction/result from the Tri-moxi is as bad as it gets. I'm a bit more convinced that my blurry blob might be related to eye reacting to the Tri-moxi. Again, the blurry blob in my right close vision eye is a slight annoyance, it is not a real problem. And... my wife and many others have no similar problems with the injections.

vic
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Last edited by Aqua Puttana; 09-07-2017 at 05:52 PM.
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Old 09-07-2017, 05:53 PM   #44
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Default Re: A DIY Eye Cataract Test

It seems as I age the world is getting fuzzier, dimmer and colder. I wish your wife a full recovery!
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